1. Neighborhood disadvantage and racial disparities in colorectal cancer incidence: a population-based study in Louisiana
- Author
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Qingzhao Yu, Xiao-Cheng Wu, Richard Scribner, Denise Danos, Tekeda F Ferguson, Claudia Leonardi, and Neal Simonsen
- Subjects
Adult ,Male ,Social Determinants of Health ,Epidemiology ,Binomial regression ,Social epidemiology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Residence Characteristics ,Humans ,Medicine ,030212 general & internal medicine ,Healthcare Disparities ,Disadvantage ,Aged ,Concentrated Disadvantage ,business.industry ,Incidence ,Incidence (epidemiology) ,Multilevel model ,Health Status Disparities ,Middle Aged ,Louisiana ,Confidence interval ,Socioeconomic Factors ,030220 oncology & carcinogenesis ,Relative risk ,Female ,Colorectal Neoplasms ,business ,Demography - Abstract
Purpose Colorectal cancer (CRC) continues to demonstrate racial disparities in incidence and survival in the United States. This study investigates the role of neighborhood concentrated disadvantage in racial disparities in CRC incidence in Louisiana. Methods Louisiana Tumor Registry and U.S. Census data were used to assess the incidence of CRC diagnosed in individuals 35 years and older between 2008 and 2012. Neighborhood concentrated disadvantage index (CDI) was calculated based on the PhenX Toolkit protocol. The incidence of CRC was modeled using multilevel binomial regression with individuals nested within neighborhoods. Results Our study included 10,198 cases of CRC. Adjusting for age and sex, CRC risk was 28% higher for blacks than whites (risk ratio [RR] = 1.28; 95% confidence interval [CI] = 1.22–1.33). One SD increase in CDI was associated with 14% increase in risk for whites (RR = 1.14; 95% CI = 1.10–1.18) and 5% increase for blacks (RR = 1.05; 95% CI = 1.02–1.09). After controlling for differential effects of CDI by race, racial disparities were not observed in disadvantaged areas. Conclusion CRC incidence increased with neighborhood disadvantage and racial disparities diminished with mounting disadvantage. Our results suggest additional dimensions to racial disparities in CRC outside of neighborhood disadvantage that warrants further research.
- Published
- 2018
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